Includes the following article: Healthcare Reform
Revisited Questions may be submitted online to the
'contact us' section of this website or sent
directly to: DigiCare Hearing Research &
Rehabilitation, P.O. Box 706, Rye, CO 81069, or
faxed to (719) 676-6882. Your name, address, and
telephone number along with your request are
required in order to receive a reply from the
Digicare team.
Dear Readers: While at first blush the
following treatise may seem dated, look again. For
many of the feared collectivist proposals that were
being promoted by the past administration have been
incrementally implemented, much to the detriment of
our nation's health. In 2002 we face the
consequences of such short-sightedness and if our
democratic-controlled Senate have their way, the
current morass will only get worse. Today, less than
25 cents of the Medicare dollar even reaches the
doctors and patients for which it was intended. So,
it is wise to read the following with a mind and eye
open to current trends, and, should enough citizens,
politicians and health professional awaken in time,
we might just be able to reverse course...read on:
HEALTHCARE REFORM REVISITED The Health
Security Act of 1993
By Max Stanley Chartrand, M.A.,
DigiCare Hearing Research & Rehabiliation
As a member of the Washington, D.C.- based H.E.A.L.
Committee (Healthcare Equity Action League), the
author has been actively involved in the health-
care reform effort since 1989. He feels the issues
now being debated in the United States Congress will
have more far-reaching effects upon practitioners
and end-users of hearing healtlzcare services than
any previously considered proposals.
Since writing in these pages two years ago on this
subject (1991), there have been profound changes in
the drama surrounding healthcare reform in the
United States. It is my purpose to expose possible
deleterious effects upon the allied hearing profes
sions, industry and market if certain proposals are
enacted into law, and to suggest viable solutions to
preserve the most advanced and accessible healthcare
system in the world.
BEHIND CLOSED DOORS
The Clinton Administration's Health Reform Task
Force—with a select membership of about 1,000
participants and expenditures of over $16 million
dollars—worked virtually around the clock during
most of 1993 to find solutions toward primarily
government-spawned problems in the healthcare
marketplace. Deliber ations were held in strict
secrecy, in viting neither public nor press.
It now turns out that some of the task force members
were actually em ployees of large managed-care corpo
rations, administration officials who held HMO
stock, and many others still who failed to file the
required
ethics forms. Implications surrounding the very
birth of these proposals are the subject of a
plethora of com plaints and lawsuits, most notably
one by the Association of American Physicians and
Surgeons.
Deliberations were held in strict secrecy,
inviting neither public nor press. The main proposal
that was pro duced by those clandestine delibera
tions is titled H.R. 3600/S.1757 The Health Security
Act of 1993. Varia tions on the concepts of this Act
are also included in H.R.3222/S.1579 The Managed
Competition Act of 1993 (Cooper/Breaux) and H.R.
3704/S.1770 The Health Equity and Access Reform
Today Act of 1993 (Chafee/Thomas).
HEARING HEALTHCARE SCENARIO
As Congress continues to hold extensive hearings on
these and other plans, we will focus our attention
on the flagship proposal, The Health Se curity Act.
Since it's introduction in the Fall of 1993, many
analysts, econ omists, and social scientists have al
ready rendered a virtual mountain of findings as to
the profound implica tions of a plan to convert
one-seventh of the U.S. economy to complete gov
ernment control. Our concern here will be those
effects as they relate to private hearing care
practitioners and their patient families:
1. The $10 hearing exam fee. Under the 'standard
benefits pack age' there are essentially no
provisions for dispenser-based hearing health care
services in the Act, with the exception of a
diminutive $10 'hearing exam.' Payment for even that
negligible service will be re stricted to those
practitioners authorized by a regional alliance. In
fact, most current hearing healthcare third-party
reimbursement mech anisms will be abolished for all
but federal employees and certain large corporate
plans who will be exempted from the Act.
2. Abolition of community hear ing care teams. Every
study that has modeled future effects of the Act has
pointed to the virtual extinction of the family
doctor and private neigh borhood clinic. Since most
hearing impaired persons depend upon these
practitioners, including otolaryngol ogists, for
medical evaluations and clearances before purchasing
hearing aids, it is safe to assume that the Act will
pose unique obstacles in the FDA- prescribed path to
hearing help for most of the population.
Long established
dispenser/audiologist/otolaryngology teams will be
come unfeasible under the new plans offered in the
Act. Discouragement of referrals to medical
specialists is a key component of cost-control in
the Act, as well as incentive bonuses awarded to
alliance 'gatekeepers' who limit such referrals.
Let’s say that you, as a hearing health
professional, work particularly well with a certain
physician, and that particular doctor is not in the
plan or alliance of your patient. If you send your
patient to that doc tor, and the doctor receives
payment from the patient, all three parties (you,
patient, and doctor) may each receive criminal
penalties and fines of $10,000 for each occurrence
under provisions of the Act.
3. The future of cochlear implants. There is
considerable concern over the fact that cochlear
implants are not included in any of the benefits
packages under The Health Secu rity Act. As vigorous
lobbying efforts continue, it is hopeful that these
may be included in any comprehensive overhaul of the
U.S. healthcare sys tem. However, any plan that
controls allocation of services through global
budgeting or other price control mechanisms would
arbitrarily re strict the number of recipients of
the procedure as experience in other nations
indicates. Hearing aids or re lated aural
rehabilitative services are certainly not expected
to be part of the package.
4. The Health Security Card. When the president
flashed that shiny, plastic 'Health Security Card'
that 'could never be taken away,' he was not
exhibiting a credit card or a club privilege card.
He was waving what one commentator called a 'Ration
Card.' Actually, an equally grave concern is the
loss of professional/patient confidentiality
signified by the enrollment card. Whereas, under the
present system such information is immune to pry ing
eyes, under The Health Security Act—or any
government controlled healthcare system—one's health
and medical history becomes an open book via a
centralized computer data system. It would also
negate the 'Patient's Bill of Rights' adopted by the
American Hospital Association House of Delegates in
1973, which have codified most of today's consumer
protections in healthcare.
5. No industry representation. Under the Act, no
representatives from any health-related agency can
serve on the board of directors of the various
alliances. These councils will be charged with
making sweeping decisions as to which services,
products and professionals come under each plan's
guidelines. At the national level where management
and quality standards are set by a 'National Quality
Management Council,' no doctor, health-care
provider, insurance provider, or anyone connected
with the healthcare indus try will be allowed to
serve. Tax credits for those under a certain income
level who purchase coverage will assure that
everyone has access to health insurance coverage.
Should hearing instruments ever be included in the
plan, the whole review and implementation process
will be entirely out of the hands of the hearing
industry. Such decisions as prices, models,
technology, and regulatory patterns will be decided
by these various oversight councils, in cluding FDA,
and the Department of Health & Human Services.
6. Effects upon the economy. Unlike the general
healthcare indus try, economic forces have an almost
immediate impact upon the private hearing industry.
Of course, much of the rise in private healthcare
costs are a direct result of cost shifting from the
public to the private sector, thereby limiting
spendable consumer income.
Various economic studies on the Act have rendered
the following ef fects upon the U.S. economy, which
inevitably would, in turn, affect sales of
non-covered items such as hear ing aids:
Between 1.5 to 3 million workers are expected to lose their jobs, and
at least 23 million more will suffer reduced wages
as a result of the employer/employee mandate.
Healthcare 'premiums' of at least 60 million
Americans will increase.
Subsidies for smaller businesses will cost an
estimated $81 billion dur ing 1996 alone. Subsidies
create in centives to keep wages and worker census
under the levels required for eligibility.
'Community ratings' will force in dividuals and
industries away from most urban areas where crime,
drugs, AIDs, and other socially driven healthcare
costs proliferate.
Lawsuits, political gerrymandering over alliance
boundaries, and con stant special interest posturing
will cause a significant drain on resources and
finances.
New medical technology and drug breakthroughs
are expected to fall to the level of other
socialized societies.
WHERE TO FROM HERE?
Instead of emphasizing proposals that will shift
power and control to the government, which will only
serve to enlarge existing problems, I suggest the
following free-market solutions:
1. Individual and family incentives. If we really
want powerful market-based incentives, control of
decisions pertaining to healthcare and health habits
need to be in the hands of individuals and families.
Medical Savings Accounts (Medical IRAs) accompanied
with supplemen tary high-deductible insurance poli
cies to meet catastrophic needs can cut healthcare
costs by half for the average family, according to
economist Milton Friedman and others.
Tax credits for those under a cer tain income level
who purchase coverage will assure that everyone has
access to health insurance coverage. Instead of
tying funding of failed programs to dubious 'sin
taxes,' individuals would voluntarily embrace
healthier lifestyles because they are financially
rewarded in doing so.
2. Insurance regulatory reform. Another suggestion
is to abolish more than 800 unnecessary state and
fed eral regulations that currently prevent the
insurance industry from providing instruments that
are more amenable to the market. This would include
allowing all Americans to enjoy first-rate, yet
economical health insurance coverage similar to
federal employees.
3. Medicare/Medicaid reform. As of this writing, the
only segment of the U.S. healthcare system that is
wildly out of control are those ad ministered by
government, primarily Medicare and Medicaid. Undoubt
edly, the cost overruns, excesses, and cost shifting
from these programs have been the single largest
contributors to problems at the private level.
Some of the answers include changing funding from
federal to local and state sources (where it costs
about V's less to spend a tax dollar compared to the
federal level). In addition, day to day management
of these systems should be contracted out to the
more efficient private firms with only 1)01 icing
oversight by government.
Other changes include changing eligibility
requirements so as not to provi(le such strong
incentives for recipients to illegally hide assets,
quit jobs, and dissolve marriages; or in
reimbursement methods that do not abet overbillings,
unnecessary tests, and multi-million dollar scams by
providers.
Federal Employees Health Benefits Plan (FEHBP)
Affording all citizens the same op portunity as
federal employees and retirees will empower
consumers to choose from among dozens of com
petitive private health plans, which are not
hamstrung from useless reg ulation, but cost an
average of 35 less than comparable policies under
existing regulation.
EFFECTS UPON OLDER AMERICANS
It is puzzling why the largest senior citizen
association in the coun try so strongly supports The
Health Security Act. Experience of other collective
healthcare systems shows that the elderly suffer the
most under allocation of capped healthcare
resources.
For instance, Great Britain—long considered the
epitome of social ized medicine—pronounces a virtual
death sentence upon those who need kidney dialysis
after age 55, the age where dialysis is most often
needed.
The wait for hip replacement is over two years.
Prostate and breast cancer treatment is rationed to
the elderly, as are breakthrough drugs and advanced
diagnostic procedures. Heart bypasses, routine in
the U.S., are comparatively rare in countries with
socialized medicine. Waiting lists abound.
Just 16% of the U.S. population—mostly those over
65—use 80% of all healthcare services today. As the
aging of America continues, the pressure will ever
be to call upon senior Americans to make the
greatest sacrifices under the socialized model.
Tort reform relative to frivolous malpractice suits
also needs atten tion. This will go far in changing
the defensive medicine climate in today's healthcare
system, and will save up to 10% in present spending
levels.
CONCLUSION
Objective analysis shows The 1993 Healthcare
Security Act to be historically the largest transfer
of power and control over a segment of America's
free market economy to government. It simply takes
problems primarily re sulting from present
government programs and forces the rest of the
population to suffer under them.
The quandary presently affecting the private hearing
healthcare delivery system may prove to pale in com
parison to the threat posed by cur rently-debated
healthcare reform proposals. Therefore, it is
incumbent upon every hearing healthcare pro vider to
become fully aware of the potential effects of
current reform proposals, and to make their voice
heard by those who may—intention ally or not—make
the ultimate de cisions about the future of hearing
healthcare in the United States.
REFERENCES
Anderson, J. Medicaid fraud costs millions,'
syndicated column, April, 1994.
Bauman, Robert E., 'The VA's War on Health,' The
Wall Street Journal, December 6, 1993.
Chartrand, MS., 'Healthcare Reform and the Private
Practitioner,' Atidecibe!, Summer, 1992.
CONSAD Research Corporation, 'Employment and Related
Economic Effects of Health Care Reform,' l-lealthcare
Equity Action I.eague, April, 1994.
Dixon, Jennifer, 'Able draw disability but ill
wait,' Wall Street Journal, April 27, 1994.
Goldberg, Robert M., 'Race Against the Cure:
The Health Hazards of Pharmaceutical Price
Controls,' Policy Review, No. 68, 1994.
Goodman, John C., and Musgrave, Gerald 1.., l'atient
l'ower: The Free Enterprise Alternative to Clinton's
Health Plan, Washington, D.C.: Cato Institute, 1994.
Gramm, Sen. Phil, Letter to the author, Oct. 28,
1993.
McGaughey, Elizabeth, 'No Exit,' Tue New Republic,
January, 1994.
McNaught, Francis (I., Commissioned Study on Pay or
Play, U.S. Department of Labor, January, 1992.
Moffitt, Robert E., 'Clinton’s Frankenstein:
the Gory Details of the President’s Plan,' Policy
Review, No. 67, 1994.
Schlafly, Phyllis, 'How will your congressman vote
on health care?,' Alton, Ill.: Eagle Forum, February
1994.
Snow, Tony, 'Real Competition Works Better,' USA
Today, May 2, 1994.
Specter, Sen. Arli n, Letter concermu jug
or,ganization of tile President Is health p April
26, 1994.
Ulbrich, Jeffrey 'Health care fraud cost (lana dians,'
Associated Press, May 9, 1994.
Urban Institute, Current Population Survey; Transfer
Income Model, March, 1990.
Zedlewski, G., Wheaton, L., Winterbottom, C., Pay or
Play Employer Mandates: Effects on Insurance
Coverage, Urban Institute, 1992.
Dr. Chartrand serves as director of research at
DigiCare Hearing Research & Rehabilitation.
Communications may be faxed to: 719-676-6882.
|
|
|
|
|
